309 DOES VARIATION IN EITHER AGE AT START OF THERAPY OR DURATION OF THERAPY MAKE CHEMOPREVENTION WITH FINASTERIDE COST-EFFECTIVE?

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness1 Apr 2011309 DOES VARIATION IN EITHER AGE AT START OF THERAPY OR DURATION OF THERAPY MAKE CHEMOPREVENTION WITH FINASTERIDE COST-EFFECTIVE? Suzanne Biehn Stewart, Charles Scales, Judd Moul, and Shelby Reed Suzanne Biehn StewartSuzanne Biehn Stewart Durham, NC More articles by this author , Charles ScalesCharles Scales Durham, NC More articles by this author , Judd MoulJudd Moul Durham, NC More articles by this author , and Shelby ReedShelby Reed Durham, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2628AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Finasteride is an effective chemoprevention therapy for prostate cancer. However, previous studies have shown that widespread utilization of finasteride for prostate cancer prevention is likely not a cost−effective strategy. The majority of these analyses are based on a model where chemoprevention is started in men aged 50−55 years. The influence of varying age at start of therapy and duration of chemoprevention on the cost−effectiveness of finasteride has not been investigated. We sought to evaluate the impact of varying both age at commencement of therapy and length of therapy on the cost−effectiveness of finasteride. METHODS A Markov model with probabilistic sensitivity analysis was designed to estimate lifetime prostate health related costs, survival, and quality−adjusted survival for men receiving or not receiving chemoprevention with finasteride. Model assumptions were based on PCPT, SEER, national cancer registries, and medical literature. The model was continued to age 85, as the average remaining life expectancy at age 75 in the US is 10 years. Incremental cost−effective ratios (ICER) of models varying in age at start of therapy and duration of chemoprevention were compared. RESULTS In the base case analysis, the ICER for men starting chemoprevention with finasteride at age 50 years was $86,600 per quality adjusted life year (QALY) (95% CI: $57,900−$147,300) when assuming finasteride reduces all grades of prostate cancer by 24.8%. When age at start of therapy is increased, the ICERs initially trend downward, nadir at an age of 65 years, ICER $65,600 per QALY (95% CI: $45,500−$112,100), and then subsequently rise to where commencing therapy at age 80, the ICER is $78,300 per QALY (95% CI: $49,600−$139,000). At each age of therapy commencement, sensitivity analysis of duration of chemoprevention showed that stopping use at age 80 was most cost−effective. CONCLUSIONS Assuming equal effectiveness at all ages and across years of treatment, the cost−effectiveness of chemoprevention with finasteride is optimized when initiated at age 65 and continued until age 80 years. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e126 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Suzanne Biehn Stewart Durham, NC More articles by this author Charles Scales Durham, NC More articles by this author Judd Moul Durham, NC More articles by this author Shelby Reed Durham, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...